Utilization Management Nurse

Mass General Brigham Health Plan Holding Company, Inc.

Somerville, MA, US
$90,000 to $107,000 annually; not specified; compr...
Fully remote
Clinical review utilizing interqual
Prior authorization experience
Managed care setting experience
The UMCM will utilize clinical knowledge to analyze, assess, and render approval decisions, to determine the need for physician review as well as complete determinations following physician review

Job Summary

  • The UMCM will utilize clinical knowledge to analyze, assess, and render approval decisions, to determine the need for physician review as well as complete determinations following physician review.
  • Mass General Brigham Health Plan is an exciting place to be within the healthcare industry, offering competitive salaries and a benefits package with flexible work options and career growth opportunities.
  • This is a remote role with occasional onsite team meetings in Somerville, MA, requiring availability for on-call duties at least once per month.

Matching Summary

The UMCM will utilize clinical knowledge to analyze, assess, and render approval decisions, to determine the need for physician review as well as complete determinations following physician review.

Salary

$90,000 to $107,000 annually; Not specified; Comprehensive benefits

Skills & Requirements

Must-have

  • Clinical review utilizing Interqual
  • Prior authorization experience
  • Managed care setting experience
  • Commercial health plan knowledge
  • Adherence to performance metrics
  • Microsoft Office Suite proficiency

Nice-to-have

  • Strong aptitude for technology
  • Ability to inject energy
  • Exercise self-awareness
  • Accountable for high-quality work
  • Bring fresh ideas forward

Key Requirements

  • Associate's Degree Nursing required or Bachelor's Degree Nursing preferred
  • Massachusetts Registered Nurse (RN) license required
  • 2-3 years utilization review experience highly preferred
  • 1-2 years payer setting experience highly preferred
  • 1-2 years acute care setting experience highly preferred

Work Rights

Not specified

Tailored Resume

Cover Letter